Ground realities in building effective Aboriginal suicide prevention strategies

Aboriginal people in Australia take their lives at rates that are twice that of non-Aboriginal people (Australian Bureau of Statistics, 2012). Although there is a National Strategy for the prevention of Aboriginal suicide (Australian Government, 2013), there is currently little evidence on effective suicide prevention strategies (Ridani et al., 2015). This is probably due to several reasons. For instance, Aboriginal suicidology is considered different from that of suicidology of mainstream populations (Elliott-Farrelly, 2004) and hence requires a unique approach. Factors associated with Aboriginal suicide are remarkably complex and almost always include intergenerational trauma, grief and loss (Australian Government, 2013) as well as obstacles to seeking help (Isaacs, Sutton, Hearn, Wanganeen, & Dudgeon, 2016). Furthermore, factors that may promote social and emotional well-being such as social connectedness and strengthening family bonds (Hunter & Milroy, 2006; Tsey, Patterson, Whiteside, Baird, & Baird, 2002) require a whole of community effort with substantial support from mainstream stakeholders.

This special issue was proposed to showcase small but significant community models that were developed to address the problem of Aboriginal suicide in Australia that have the potential to make a difference to the current suicide prevention landscape. Nonetheless, it is becoming increasingly clear that for any meaningful change to occur, mainstream services and Aboriginal communities need to ‘work together’ (Dudgeon, Milroy, & Walker, 2014; Sheldon, 2001). Currently there is some way to go before this can be achieved.

In the first paper of this issue, Wright, Lin, and O’Connell (2016) invite the reader to engage with Aboriginal people and their communities and Elders by sharing their experiences of working together. In doing so, they describe the importance of being humble, inquisitive and open. While we do acknowledge that Aboriginal communities might follow different engagement protocols across Australia, the basic tenets of engagement remain more similar than different. Perhaps the first and most important pre-requisite for the development of an Aboriginal suicide prevention program is meaningful and result-oriented engagement between Aboriginal people and mainstream organisations.

The next paper by Hearn, Wanganeen, Sutton, and Isaacs (2016) describes a model of early identification of individuals with psychological distress and suicidal ideation. As part of a suicide prevention program, Njernda Aboriginal Corporation trained selected individuals from their community who formed a group of support persons to meet with those identified as being in distress on a weekly basis, thereby supporting them and monitoring their well-being. Like most Aboriginal models, this model is also in its initial stages of implementation with no available data on outcomes or effectiveness.

The third paper by Kuipers, Lindeman, Grante, and Dingwall (2016) describes the gaps in service provision for Aboriginal young people who have harmed themselves. They highlight the continuing absence of meaningful services, the slow responsiveness of services and the lack of intersectoral coordination. They also discuss the challenges faced by Aboriginal workers on the ground and the need for more support and upskilling of the workforce.

In the fourth paper of this issue Isaacs and Sutton (2016) describe a comprehensive suicide prevention strategy developed by Njernda Aboriginal Corporation. This strategy is built on three pillars – building resilience, early intervention response and immediate postvention support. Over a three-year period, a dedicated suicide prevention project worker developed activities that focused on resilience building and early intervention. This he did with the help of his co-workers. The work of Njernda clearly demonstrates, what is possible when Aboriginal organisations receive the support and encouragement they need in developing programs for their communities.

The final paper in this issue is The Gayaa Dhuwi (Proud Spirit) Declaration by Dudgeon, Calma, Brideson, and Holland (2016). The Gayaa Dhuwi (Proud Spirit) Declaration is an Australian companion to the international 2010 Wharerātā Declaration (Sones et al., 2010) which promotes Indigenous leadership within mental health systems as a foundation for improving its responsiveness to Indigenous peoples’ mental health. The paper includes a Call to Action aimed at Commonwealth and State and Territory governments, mental health services, professional bodies and relevant education institutions. It asks these bodies to formally commit to, and begin the implementation of, The Gayaa Dhuwi (Proud Spirit) Declaration as a priority. The Declaration is already supported by the Australian mental health commissions.

The papers in this issue highlight three important lessons. First, gaps in service provision, slow responsiveness of services and the lack of intersectoral coordination continue to plague delivery of care thereby rendering current suicide prevention programs for Aboriginal people largely ineffective. Second, there is a need for more meaningful engagement between mainstream agencies and Aboriginal organisations. These relationships are usually built by key individuals from both sides (Fuller et al., 2005) and require humility, inquisitiveness and openness. Third, Aboriginal people and organisations are more than capable of developing suicide prevention programs for their communities if they receive adequate support in the form of funding, technical expertise and encouragement through relationships built on trust. The Gayaa Dhuwi declaration calls for a policy change to enable implementation of services that better suit Aboriginal people.